J Pathol Transl Med.  2015 May;49(3):218-229. 10.4132/jptm.2015.04.15.

Pathology-MRI Correlation of Hepatocarcinogenesis: Recent Update

• Huh J
• Kim KW
• Kim J
• Yu E

• KMID: 2381380
• DOI: http://doi.org/10.4132/jptm.2015.04.15

Abstract

Understanding the important alterations during hepatocarcinogenesis as well as the characteristic magnetic resonance imaging (MRI) and histopathological features will be helpful for managing patients with chronic liver disease and hepatocellular carcinoma. Recent advances in MRI techniques, such as fat/iron quantification, diffusion-weighted images, and gadoxetic acid-enhanced MRI, have greatly enhanced our understanding of hepatocarcinogenesis.

Keyword

Hepatocarcinogenesis; Magnetic resonance image; Carcinoma, hepatocellular; Pathology

MeSH Terms

Carcinoma, Hepatocellular
Humans
Liver Diseases
Magnetic Resonance Imaging
Pathology

Figure

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  Fig. 1. Schematic view of multistep hepatocarcinogenesis. Unpaired arterial supply replaces portal supply progressively from regenerative nodules to progressed hepatocellular carcinoma (yellow, nodules with portal supply; red, nodules with unpaired arterial supply). Degrees of various pathologic components are depicted as gradient bars. DN, dysplastic nodule; HCC, hepatocellular carcinoma; HG, high grade; LG, low grade; RN, regenerative nodule.

• 

  Fig. 2. Representative pathologic images of multistep hepatocarcinogenesis. (A) Low-grade dysplastic nodule (right of the dashed line) shows increased cellularity, and residual portal tracts (arrow) are easily identifiable within the nodule. (B) High-grade dysplastic nodule (left of the dashed line) shows further increased cellularity and frequent unpaired arteries (arrow). (C) Early hepatocellular carcinoma (below the dashed line) is poorly demarcated but shows unequivocal cytological atypia and stromal invasion (arrow). (D) Advanced hepatocellular carcinoma is well demarcated by a thick capsule and shows overt features of malignancy.

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  Fig. 3. Routine magnetic resonance imaging sequences. (A) T2-weighted imaging is helpful for the differential diagnosis of liver tumors. Hepatocellular carcinoma (HCC) usually shows intermediate high-signal intensity (arrowheads on the left), whereas hepatic cysts show bright high-signal intensity (arrow on the right). (B) In-phase and opposed-phase images provide information regarding the fat or iron content of hepatocellular nodules. The fat component of a nodule is seen as high-signal intensity on in-phase imaging (arrowhead on the left) and as low-signal intensity on opposed-phase imaging (arrow on the middle). On histology of the resected specimen, the nodule is confirmed as a fat-containing HCC. (C) Multiphasic dynamic images and hepatobiliary-phase images. After contrast injection, T1-weighted images are obtained in the arterial phase (AP), portal-venous phase (PVP), three-minute, delayed equilibrium phase (EP), and 20-minute, delayed hepatobiliary phase (HBP) to provide hemodynamic information regarding liver tumors. An HCC (arrowheads) shows typical hemodynamic features, including enhancement on AP, and washout on PVP and EP. On HBP, the HCC is seen as a hypodense mass. (D) Diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) map are helpful for evaluating the cellularity of a liver tumor. HCC mostly shows high signal intensity on DWI (arrow on the left) and low signal on the ADC map (arrowheads on the right).

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  Fig. 4. Nodule-in-nodule pattern of hepatocellular carcinoma (HCC). On a multiphasic, dynamic magnetic resonance imaging of a 50-year-old patient with HCC, there is a large mass without arterial hypervascularity (arrowheads on the left) and a sub-nodule with strong arterial hypervascularity (asterisk on the left) on the arterial-phase image, i.e., the so-called nodule-in-nodule pattern. The central sub-nodule shows washout on the portal-venous phase (asterisk in the middle). After the patient was treated with transarterial chemoembolization, lipiodol was taken up only in the sub-nodule (asterisk on the right). These findings suggest the presence of HCC as a sub-nodule arising from a large dysplastic nodule.

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  Fig. 5. Tumor capsule of the hepatocellular carcinoma (HCC). The tumor capsule (arrowheads) is seen as a hypointense rim on the arterial-phase (AP) image (left) and as an enhancing rim on the portal-venous phase (PVP) image (middle), indicating a delayed and persistent enhancement pattern. On T2-weighted imaging (T2-WI), the tumor capsule is seen as a hyperintense rim (right).

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  Fig. 6. Siderotic nodule. A 60-year-old patient with liver cirrhosis underwent liver magnetic resonance imaging. On in-phase images, there are many nodules with low signal intensity (arrowheads on the left), which are not clearly demonstrable on opposed-phase images (right). This signal drop of nodules on the in-phase image suggests that these nodules contain an iron component (so-called siderotic nodules).

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  Fig. 7. A 65-year-old patient with a liver nodule. (A) On the initial magnetic resonance imaging (MRI), there is a 1.4 cm, hypointense nodule on the portal-venous phase (PVP, arrowhead) without arterial hypervascularity (arrow) on the arterial phase (AP). This nodule was regarded as a high-grade dysplastic nodule or early hepatocellular carcinoma (HCC). (B) On the one-year follow-up MRI, the nodule had increased in size. The nodule showed hypointensity on the hepatobiliary phase (HBP, arrowheads) and arterial hypervascularity on the AP (arrow), which suggests development of HCC.

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